Friday, February 27, 2015

Tired of reaching for a bottle of pills to quell your chronic pain? Maybe you should strap on a virtual reality headset. In an experiment described last week in Psychological Science, scientists showed how bogus visual feedback created by virtual reality can actually trick the brain into boosting or reducing a person's range of pain-free movement. The study highlights the ways in which sensory perceptions, and not just physical signals, can make us feel pain—and how that effect can be manipulated to design new therapies.

To test this notion, Daniel Harvie at the University of South Australia and his colleagues put chronic neck pain sufferers through a series of twists and turns, first with no equipment and then fitted with Oculus Rift headsets. The headsets were programmed to show indoor and outdoor scenes, and they used gyroscopes to monitor the wearer's head movements. The patients were then told to turn their heads left or right until they felt pain.

When patients turned their heads just a bit, they sometimes perceived that they were moving much further, or vice versa. If participants moved their heads within a normally non-painful range, they experienced pain when the headset's visuals made them think they'd performed a much greater rotation. Similarly, the volunteers often experienced no pain when the headsets made it appear to them that they'd performed smaller, normally pain-free turns—even if they moved into a normally painful pose. The results suggest that chronic sufferers create an association between movement and pain, so that the mere visual suggestion of motion its own signal of danger to the body.

"It is important to recognize here what pain actually is," Harvie says. "Pain is not a linear result of messages from the body. Rather, pain is one of the brain's protective responses, produced when, after evaluating all of the evidence, it decides that body tissue is in danger and that we need warning. In this case, because of the association between pain and movement, learned through past experience, visual signals of movement themselves have become signals of threat to the body and therefore, triggers of pain."

Virtual reality has been used previously for other types of pain research. In 2014 Swedish scientists detailed in the journal Frontiers in Neuroscience how virtual reality helped phantom limb pain, which plagues some 70 percent of amputees. Muscle signals from a patient's stump were recorded by electrodes and processed by a software program that enabled each patient to control a virtual limb just by thinking about it. The treatment caused a reduction in phantom pain, perhaps because the illusion tricked the brain into thinking that the missing limb was again part of the body.

Harvie sees similar potential for developing future pain treatments based on his team's research, such as training the brain to target the cues it interprets as danger signals.

"Movement is a common example of something that is often associated with pain when we have an injury, and might therefore become a 'learned' signal of danger and trigger of pain, even after injury healing," he says. "If we can teach the brain anew that movement and other learned triggers are actually safe, then their ability to contribute to pain will be extinguished."

Saturday, February 21, 2015

When you whack yourself with a hammer, it feels like the pain is in your thumb. But really it's in your brain.

That's because our perception of pain is shaped by brain circuits that are constantly filtering the information coming from our sensory nerves, says David Linden, a professor of neuroscience at Johns Hopkins University and author of the new book Touch: The Science of Hand, Heart, and Mind.

"The brain can say, 'Hey that's interesting. Turn up the volume on this pain information that's coming in,' " Linden says. "Or it can say, 'Oh no — let's turn down the volume on that and pay less attention to it.' "

This ability to modulate pain explains the experiences of people like Dwayne Turner, an Army combat medic in Iraq who received the Silver Star for valor.

In 2003, Turner was unloading supplies when his unit came under attack. He was wounded by a grenade. "He took shrapnel in his leg, in his side — and he didn't even notice that he had been hit," Linden says.

Despite his injuries, Turner began giving first aid and pulled other soldiers to safety. As he worked, he was shot twice — one bullet breaking a bone in his arm. Yet Turner would say later that he felt almost no pain.

"Soldiers in the heat of the moment don't recognize the pain that's happening," Linden says. But once that moment is over, those same soldiers may feel a lot of pain from something minor, like a hypodermic needle, he says.

The brain also determines the emotion we attach to each painful experience, Linden says. That's possible, he explains, because the brain uses two different systems to process pain information coming from our nerve endings.

One system determines the pain's location, intensity and characteristics: stabbing, aching, burning, etc.

"And then," Linden says, "there is a completely separate system for the emotional aspect of pain — the part that makes us go, 'Ow! This is terrible.' "

Friday, February 06, 2015

Chronic pain is at epidemic levels and has become the highest-cost condition in health care. This course uses evidence-based science with creative and experiential learning to better understand chronic pain conditions and how they can be prevented through self-management in our cognitive, behavioral, physical, emotional, spiritual, social, and environmental realms.

Chronic musculoskeletal pain (including head, neck, and back pain) is a significant cause of suffering, disability, and health care in the world. Care for chronic pain often involves surgery, multiple medications (including opioids), endless physical and chiropractic therapy, injections, implanted devices, and other passive treatments-- making it the highest cost condition in health care. The burden upon individuals in terms of ongoing pain and suffering is incalculable.

Consider an alternative. By using a human systems approach, we can better understand how individual risk factors in the cognitive, behavioral, physical, emotional, spiritual, social, and environmental realms of our lives can interact to perpetuate chronic pain and, if improved, can prevent it.

During this course, you will: Identify the problems of our health care system in dealing with chronic pain. Review the diagnosis, mechanisms, and etiology of chronic pain conditions. Explore specific risk factors that can contribute to chronic pain. Learn how a human systems approach can be applied through evidence-based self-management strategies to prevent chronic pain. Experience active strategies designed to enhance the protective factors that can transform our own lives, and those of our patients, to one of health and wellness.

This course was first offered in spring of 2014. The course evaluations were carefully reviewed and the course was modified to improve its quality. Overall, 91% of participants believed the overall experience was satisfying, 92% believed it met the objectives, 93% believed that it made a difference in their life, and 85% believed that it made a difference in the care of patients.

Did you know that chronic pain is now at epidemic levels and has become the highest-cost condition in health care? Would you like to learn more about chronic pain conditions and how they can be prevented?

Chronic pain – including orofacial, head, neck and back pain – is the most prevalent chronic condition, the top reason for health care visits, and the primary driver of health care costs. The personal cost of chronic pain can be devastating resulting in loss of function, disability, depression, addiction and suicide. This unique educational experience utilizes creative, experiential teaching methods and evidence-based information to help you understand chronic pain conditions and how they can be prevented through self-management. Emphasis will be placed on using a human systems approach to appreciate how risk factors in the cognitive, behavioral, physical, emotional, spiritual, social and environmental realms of life can interact to perpetuate chronic pain. You will take away from this course specific strategies to enhance protective factors that can transform your life and the lives of your patients to one of health and wellness.